EX Account Request Form
This form is to request a new (or re-activation of an) account for the Jenzabar EX System
Please complete and send this form and if there are any questions please contact Anthony Walker in the Administrative Systems Department. Ext: 8441
Person Being Replaced
Only if Applies
Signature of Department Head
Sensitive Information Training Certificate
File upload limit:
(1) THIS USER ACCOUNT WILL GRANT ME ACCESS TO INFORMATION THAT IS SENSITIVE AND/OR PROTECTED BY LAW. I UNDERSTAND THAT I HAVE BEEN PROVIDED ACCESS TO THIS INFORMATION FOR THE SOLE PURPOSE(S) OF PERFORMING MY DUTIES. (2) TO MAINTAIN THE INTEGRITY OF THE SYSTEM, I WILL NOT SHARE THIS ACCOUNT INFORMATION WITH ANYONE AND WILL COMMIT MY PASSWORD TO MEMORY. (3) IN THE EVENT THAT THE SECURITY OF MY USER ACCOUNT IS COMPROMISED, I WILL NOTIFY THE SYSTEM ADMINISTRATOR IMMEDIATELY. FAILURE TO PROTECT MY USER ACCOUNT COULD RESULT IN LIMITED OR TERMINATION OF ACCESS.
Signature of Employee
My signature on this document certifies that I have read, understood, and agree to comply with the aforementioned policy.
Please install Adobe® Flash® Player system plug-in to draw your signature